হার্ট অ্যাটাকের ম্যানেজমেন্ট –

আপনি মনে করুন, উপজেলা লেভেলে কোথাও আছেন- বুকে ব্যাথা নিয়ে রোগী আসলো,

ইসিজি করে কনফার্ম হলেন, পেশেন্ট এর হার্ট অ্যাটাক হয়ে গেছে, কি করবেন?

আপনি যদি বুঝেন, হার্ট অ্যাটাকে কি হয়ে থাকে, তাহলে আপনি সহজেই ম্যানেজমেন্ট দিতে পারবেন,

হার্ট অ্যাটাকে যা হয়-

১.. করোনারি আর্ট্যারিতে Atherosclerotic Plaque এর সাথে প্ল্যাটিলেট এসে একটা রক্তের চাকা তৈরি হয়ে আর্ট্যারি কে ব্লক করে দেয়, তাহলে platelet যেনো জমাট বাঁধতে না পারে, আপনাকে এন্টি প্ল্যাটিলেট ড্রাগ হাইডোজ (লোডিং ডোজে দিয়ে দিতে হবে, এতে করে প্ল্যাটিলেট জমাট বাধা রোধ হবে-

Tablet 1.Anclog75 mg ( AS A Clopidogrel Bisulphate Anti-platelet drugs) ৪ টা ট্যাবলেট এক সাথে khabe.

Indications of Tablet :-Anclog75 mg ( AS A Clopidogrel Bisulphate Anti-platelet drugs):-

Acute Coronary Syndrome (ACS): Anclog tablet is indicated to reduce the rate of myocardial infarction (MI) and stroke in patients with non-ST-segment elevation ACS [unstable angina (UA)/non-ST-elevation myocardial infarction (NSTEMI)]. It is indicated to reduce the rate of myocardial infarction and stroke in patients with acute ST-elevation myocardial infarction (STEMI).

Recent MI, recent Stroke, or established Peripheral Arterial Disease: In patients with established peripheral arterial disease or with a history of recent myocardial infarction (MI) or recent stroke Anclog tablet is indicated to reduce the rate of MI and stroke.

Pharmacology of Tablet :-Anclog75 mg ( AS A Clopidogrel Bisulphate Anti-platelet drugs):-

Clopidogrel is a prodrug. It inhibits platelet activation and aggregation through the irreversible binding of its active metabolite to the P2Y12 class of ADP receptors on platelets. Dose-dependent inhibition of platelet aggregation can be seen 2 hours after single oral doses. Repeated doses of 75 mg per day inhibit ADP-induced platelet aggregation on the first day, and inhibition reaches steady state between Day 3 and Day 7.

Dosage & Administration of Tablet :-Anclog75 mg ( AS A Clopidogrel Bisulphate Anti-platelet drugs):-

Acute Coronary Syndrome: In patients who need an antiplatelet effect within hours, initiate clopidogrel with a single 300 mg (4 tablets) oral loading dose and then continue at 75 mg once daily. Initiating it without a loading dose will delay establishment of an antiplatelet effect by several days.

Recent MI, Recent Stroke, or Established Peripheral Arterial Disease: 75 mg once daily orally without a loading dose.

It is given orally with or without food.

Interaction of Tablet :-Anclog75 mg ( AS A Clopidogrel Bisulphate Anti-platelet drugs):-

• NSAIDs, warfarin, selective serotonin and serotonin norepinephrine reuptake inhibitors (SSRIs, SNRIs): Increases risk of bleeding
• CYP2C19 inhibitors (omeprazole or esomeprazole): Avoid concomitant use of omeprazole or esomeprazole
• Repaglinide (CYP2C8 substrates): Avoid concomitant use of Anclog with Repaglinide as it increases plasma concentrations of Repaglinide

Contraindications of Tablet :-Anclog75 mg ( AS A Clopidogrel Bisulphate Anti-platelet drugs):-

Clopidogrel is contraindicated in the following conditions: Hypersensitivity to the drug substance or any component of the product. Active pathological bleeding such as peptic ulcer or intracranial hemorrhage.

Side Effects of Tablet :-Anclog75 mg ( AS A Clopidogrel Bisulphate Anti-platelet drugs):-

Anclog is generally well tolerated drug.

• Common side effects: Bleeding, Diarrhoea, gastrointestinal discomfort, haemorrhage, Skin reactions.
• Rare side effects: Acquired haemophilia, anaemia, angioedema, arthralgia, arthritis, bone marrow disorders.

Pregnancy & Lactation of Tablet :-Anclog75 mg ( AS A Clopidogrel Bisulphate Anti-platelet drugs):-

There are no adequate and well-controlled studies in pregnant women. It should be used during pregnancy only if clearly needed. It is unknown whether clopidogrel is excreted in human breast milk. A decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

Tablet2:-Carva 75 mg  (AS A Aspirin Anti-platelet drugs )৪ টা ট্যাবলেট এক সাথে khabe.

Indications of Tablet:-Carva 75 mg  (AS A Aspirin Anti-platelet drugs ):-

Carva is indicated in the following indications-

• Prophylaxis against arterial occlusive events: Myocardial infarction, myocardial re-infarction, after bypass surgery, acute ischaemic stroke/TIA.
• Mild to moderate pain: Headache, muscle pain, dysmenorrhoea and toothache etc.
• Chronic disease accompanied by pain and inflammation: Osteoarthritis.
• Antipyretic: Cold fever and influenzae.

Pharmacology of Tablet:-Carva 75 mg  (AS A Aspirin Anti-platelet drugs ):-

By decreasing platelet aggregation, Aspirin inhibits thrombus formation on the arterial side of the circulation, where thrombi are formed by platelet aggregation and anticoagulants have little effect. Aspirin is the analgesic of choice for headache, transient musculoskeletal pain and dysmenorrhoea. It has anti-inflammatory and antipyretic properties, which may be useful. Enteric-coated Aspirin reduces intestinal disturbance and gastrointestinal ulceration due to aspirin.

Dosage & Administration of Tablet:-Carva 75 mg  (AS A Aspirin Anti-platelet drugs ):-

Pain, inflammatory diseases and as antipyretic: Aspirin 300 mg 1-3 tablets 6 hourly with a maximum daily dose of 4 gm.

Suspected acute coronary syndrome: 150 mg-300 mg immediately unless there are clear contraindications.

After myocardial infarction: Aspirin 150 mg daily for 1 month. Long-term use of aspirin in a dose of 75 mg daily is recommended thereafter.

Acute ischaemic stroke/Transient ischaemic stroke (TIA): The starting dose is 150 mg-300 mg daily and Aspirin 75 mg daily thereafter.

Following bypass surgery: 75 mg-300 mg daily starting 6 hours post-procedure.

Interaction of Tablet:-Carva 75 mg  (AS A Aspirin Anti-platelet drugs ):-

Salicylates may enhance the effect of anticoagulants, oral hypoglycaemic agents, phenytoin and sodium valporate. They inhibit the uricosuric effect of probenecid and may increase the toxicity of sulphonamides. They may also precipitate bronchospasm or induce attacks of asthma in susceptible subjects.

Contraindications of Tablet:-Carva 75 mg  (AS A Aspirin Anti-platelet drugs ):-

Aspirin is contraindicated to the children (Reye’s syndrome) less than 12 years, in breast-feeding and active peptic ulcer. It is also contraindicated in bleeding due to haemophilia, intracranial haemorrhage and other ulceration.

Side Effects of Tablet:-Carva 75 mg  (AS A Aspirin Anti-platelet drugs ):-

Side effects for the usual dosage of Carva are mild including nausea, dyspepsia, gastrointestinal ulceration and bronchospasm etc.

Pregnancy & Lactation of Tablet:-Carva 75 mg  (AS A Aspirin Anti-platelet drugs ):-

It is especially important not to use aspirin during the last 3 months of pregnancy unless specifically directed to do so by a doctor because it may cause problems in the unborn child or complications during delivery. Aspirin penetrates into breast milk. So, it should be administered with caution to lactating mothers.

২… যদি Inferior MI না হয়ে থাকে, তাহলে

Tab-Nidocard 2.6 mg /Spray দিবে। GTN coronary vesodialator হিসাবে কাজ করে। inferior MI হলে GTN contraindicated..

Tablet 3:Nidocard 2.6 mg (AS A Nitroglycerin AS A Nitrates: Coronary vasodilators).

Indications Tablet 3:-Nidocard 2.6 mg (AS A Nitroglycerin AS A Nitrates: Coronary vasodilators):-

 

Nidocard Retard is indicated for the prophylaxis of angina pectoris. The onset of action is not sufficiently rapid for this form to be useful in aborting an acute anginal episode.

Pharmacology Tablet 3:Nidocard 2.6 mg (AS A Nitroglycerin AS A Nitrates: Coronary vasodilators).

 

Nitroglycerin causes relaxation of vascular smooth muscle, producing a vasodilator effect on both peripheral arteries and veins. Dilation of veins promote peripheral pooling of blood and decreases venous return to the heart, thereby reducing left ventricular end-diastolic pressure (preload) and relaxation of arteries reduce systemic vascular resistance and arterial pressure (afterload).

Dosage & Administration Tablet 3:Nidocard 2.6 mg (AS A Nitroglycerin AS A Nitrates: Coronary vasodilators).

 

Dosage should always to be adjusted according to the requirement and response obtained by the individual patient and the severity of the anginal pain. For adults, one Nitroglycerin 2.6 mg sustained released tablet or capsule in morning and evening. This should be taken empty stomach.

Interaction Tablet 3:Nidocard 2.6 mg (AS A Nitroglycerin AS A Nitrates: Coronary vasodilators).

 

Nidocard Retard dilates peripheral blood vessels and may increase the antihypertensive properties of vasodilators, calcium antagonists, beta-adrenergic blockers. Concomitant use of nitrates with tricyclic antidepressants and alcohol may cause high blood pressure. Concomitant use of nitrates with phosphodiesterase type 5 (PDE5) inhibitors, such as sildenafil, vardenafil and tadalafil cause fall in blood pressure. Aspirin decreases the clearance and enhances the hemodynamic effects of Nidocard Retard. Nidocard Retard may reduce the pharmacologic effects of heparin when used concomitantly. Nitrates increase the bioavailability of dihydroergotamine.

Contraindications Tablet 3:Nidocard 2.6 mg (AS A Nitroglycerin AS A Nitrates: Coronary vasodilators).

 

Nitroglycerin is contraindicated in patients with a known hypersensitivity to nitroglycerin, other organic nitrates, or nitrites or to the excipients of the medicine. It is also contraindicated in patients with acute myocardial infarction, marked anemia, head trauma, cerebral hemorrhage, or closed angle glaucoma.

Side Effects Tablet 3:Nidocard 2.6 mg (AS A Nitroglycerin AS A Nitrates: Coronary vasodilators).

 

Headache may occur at the onset of treatment but will usually subside after a few days. If the headache persists dosage should be decreased. Other side effects include tachycardia, postural hypotension and syncope, cyanosis and methemoglobinemia.

Pregnancy & Lactation Tablet 3:Nidocard 2.6 mg (AS A Nitroglycerin AS A Nitrates: Coronary vasodilators).

 

There is no evidence relating to the safety of nitrates in pregnancy and lactation. Nitroglycerin should be administered to pregnant women and nursing mothers unless considered essential by the physician.

Precautions & Warnings Tablet 3:Nidocard 2.6 mg (AS A Nitroglycerin AS A Nitrates: Coronary vasodilators).

 

Nidocard Retard should be used with caution in patients who are predisposed to closed-angle glaucoma. As with other drugs for the treatment of angina pectoris, abrupt discontinuation of therapy may lead to exacerbation of symptoms. When discontinuing long term treatment, the dosage should be reduced gradually over several days, and the patient carefully monitored. The use of Nidocard Retard during the early days of acute myocardial infarction requires particular attention to hemodynamic monitoring and clinical status to avoid the hazards of hypotension and tachycardia.

৩৷ Lipid lowering agent দিবে Tab-Atova 40 mg

Tablet 4:- Atova 40 mg (AS A Atorvastatin Calcium AS A Other Anti-anginal & Anti-ischaemic drugs, Statins).

Indications of Tablet :- Atova 40 mg (AS A Atorvastatin Calcium AS A Other Anti-anginal & Anti-ischaemic drugs, Statins).

Atova is indicated as an adjunct to diet to reduce elevated total cholesterol, LDL cholesterol, apolipoprotein B (Apo-B) and triglycerides levels in following diseases when response to diet and other non-pharmacological measures is inadequate.

• To reduce total cholesterol and LDL cholesterol in patients with heterozygous and homozygous familial hypercholesterolemia.
• To reduce elevated cholesterol and triglycerides in patient with mixed dyslipidemia (Fredrickson Type Ia and Ib).
• For the treatment of patients with elevated serum triglyceride levels in hypertriglyceridaemia (Fredrickson Type IV).
• For the treatment of patients with dysbetalipoproteinaemia (Fredrickson Type III).
• To reduce cardiac ischaemic events in patients with asymptomatic or mild to moderate symptomatic coronary artery disease with elevated LDL-cholesterol level.
• To reduce total and LDL-cholesterol concentrations patients with hypercholesterolemia associated with or exacerbated by diabetes mellitus or renal transplantation.

Pharmacology of Tablet :- Atova 40 mg (AS A Atorvastatin Calcium AS A Other Anti-anginal & Anti-ischaemic drugs, Statins).

Atorvastatin is a selective inhibitor of HMG-CoA reductase. This enzyme is the rate-limiting enzyme responsible for the conversion of HMG-CoA to mevalonate, a precursor of sterols, including cholesterol. Atorvastatin lowers plasma cholesterol and lipoprotein levels by inhibiting HMG-CoA reductase and cholesterol synthesis in the liver and increases the number of hepatic LDL receptors on the cell surface for enhanced uptake and catabolism of LDL.

Absorption: Atorvastatin is rapidly absorbed after oral administration; maximum plasma concentrations occur within 1 to 2 hours. Extent of absorption increases in proportion to Atorvastatin dose. The absolute bioavailability of Atorvastatin (parent drug) is approximately 14% and the systemic availability of HMG-CoA reductase inhibitory activity is approximately 30%.

Distribution: Mean volume of distribution of Atorvastatin is approximately 381 liters. Atorvastatin is 98% bound to plasma proteins. A blood/plasma ratio of approximately 0.25 indicates poor drug penetration into red blood cells. Based on observations in rats, Atorvastatin is likely to be secreted in human milk.

Metabolism: Atorvastatin is extensively metabolized to ortho- and parahydroxylated derivatives and various beta-oxidation products. In vitro inhibition of HMG-CoA reductase by ortho- and parahydroxylated metabolites is equivalent to that of Atorvastatin. Approximately 70% of circulating inhibitory activity for HMG-CoA reductase is attributed to active metabolites. In vitro studies suggest the importance of Atorvastatin metabolism by cytochrome P450 3A4, consistent with increased plasma concentrations of Atorvastatin in humans following coadministration with erythromycin, a known inhibitor of this isozymes. In animals, the ortho-hydroxy metabolite undergoes further glucuronidation.

Excretion: Atorvastatin and its metabolites are eliminated primarily in bile following hepatic and/or extra-hepatic metabolism; however, the drug does not appear to undergo enterohepatic recirculation. Mean plasma elimination half-life of Atorvastatin in humans is approximately 14 hours, but the half-life of inhibitory activity for HMG-CoA reductase is 20 to 30 hours due to the contribution of active metabolites. Less than 2% of a dose of Atorvastatin is recovered in urine following oral administration.

Dosage & Administration of Tablet :- Atova 40 mg (AS A Atorvastatin Calcium AS A Other Anti-anginal & Anti-ischaemic drugs, Statins).

Primary hypercholesterolaemia and combined hyperlipidaemia-

• Adults: Usually 10 mg once daily; if necessary, may be increased at intervals of at least 4 weeks to max. 80 mg once daily.
• Child (10-18 years): Initially 10 mg once daily, increased if necessary at intervals of at least 4 weeks to usual max. 20 mg once daily.

Familial hypercholesterolaemia-

• Adults: Initially 10 mg daily, increased at intervals of at least 4 weeks to 40 mg once daily; if necessary, further increased to max. 80 mg once daily (or 40 mg once daily combined with anion-exchange resin in heterozygous familial hypercholesterolaemia).
• Child (10-18 years): Initially 10 mg once daily, increased if necessary at intervals of at least 4 weeks to usual max. 80 mg once daily.

Prevention of cardiovascular events-

• Adults: Initially 10 mg once daily adjusted according to response.

Another guideline: 

The patient should be placed on a standard cholesterol-lowering diet before receiving Atorvastatin and should continue on this diet during treatment with Atorvastatin. The recommended starting dose of Atorvastatin is 10 or 20 mg once daily. Patients who require a large reduction in LDL-C (more than 45%) may be started at 40 mg once daily. The dosage range of Atorvastatin is 10 to 80 mg once daily. Atorvastatin can be administered as a single dose at any time of the day, with or without food. After initiation of Atorvastatin lipid levels should be analyzed within 2 to 4 weeks and dosage adjusted accordingly.

In hypercholesterolemia in Pediatric Patients (10-17 years of age) the recommended starting dose of Atorvastatin is 10 mg/day; the maximum recommended dose is 20 mg/day (doses greater than 20 mg have not been studied in this patient population). Doses should be individualized according to the recommended goal of therapy. Adjustments should be made at intervals of 4 weeks or more.

Interaction of Tablet :- Atova 40 mg (AS A Atorvastatin Calcium AS A Other Anti-anginal & Anti-ischaemic drugs, Statins).

 

The risk of myopathy during treatment with drugs of this class is increased with concurrent administration of cyclosporine, fibric acid derivatives, niacin (nicotinic acid), erythromycin, azole antifungals.

Antacid: When atorvastatin and antacid suspension were coadministered, plasma concentrations of atorvastatin decreased approximately 35%. However, LDL-C reduction was not altered.

Colestipol: Plasma concentrations of atorvastatin decreased approximately 25% when colestipol and atorvastatin were coadministered. However, LDL-C reduction was greater when atorvastatin and colestipol were coadministered than when either drug was given alone.

Digoxin: When multiple doses of atorvastatin and digoxin were coadministered, steady-state plasma digoxin concentrations increased by approximately 20%. Patients taking digoxin should be monitored appropriately.

Erythromycin: In healthy individuals, plasma concentrations of atorvastatin increased approximately 40% with coadministration of atorvastatin and erythromycin, a known inhibitor of cytochrome P450 3A4.

Oral Contraceptives: Coadministration of atorvastatin and an oral contraceptive increased AUC values for norethindrone and ethinyl estradiol by approximately 30% and 20%. These increases should be considered when selecting an oral contraceptive for a woman taking atorvastatin.

Warfarin: Atova had no clinically significant effect on prothrombin time when administered to patients receiving chronic warfarin treatment.

Contraindications of Tablet :- Atova 40 mg (AS A Atorvastatin Calcium AS A Other Anti-anginal & Anti-ischaemic drugs, Statins).

 

Atorvastatin should not be used in patient with hypersensitivity to any component of this medication. Atorvastatin is contraindicated in active liver disease or unexplained persistent elevations of serum transaminases. It is also contraindicated in patient with history of serious adverse reaction to prior administration of HMG-CoA reductase inhibitors.

Side Effects of Tablet :- Atova 40 mg (AS A Atorvastatin Calcium AS A Other Anti-anginal & Anti-ischaemic drugs, Statins).

 

Atova is generally well-tolerated. The most frequent side effects related to Atova are constipation, flatulence, dyspepsia, abdominal pain. Other side effects includes infection, headache, back pain, rash, asthenia, arthralgia, myalgia.

Pregnancy & Lactation of Tablet :- Atova 40 mg (AS A Atorvastatin Calcium AS A Other Anti-anginal & Anti-ischaemic drugs, Statins).

 

Pregnancy: Atorvastatin is contraindicated during pregnancy. Safety in pregnant women has not been established. No controlled clinical trials with atorvastatin have been conducted in pregnant women. Rare reports of congenital anomalies following intrauterine exposure to HMG-CoA reductase inhibitors have been received. Animal studies have shown toxicity to reproduction. Maternal treatment with atorvastatin may reduce the fetal levels of mevalonate which is a precursor of cholesterol biosynthesis. Atorvastatin should not be used in women who are pregnant, trying to become pregnant or suspect they are pregnant. Treatment with atorvastatin should be suspended for the duration of pregnancy or until it has been determined that the woman is not pregnant

Lactation: It is not known whether atorvastatin or its metabolites are excreted in human milk. In rats, plasma concentrations of atorvastatin and its active metabolites are similar to those in milk. Because of the potential for serious adverse reactions, women taking atorvastatin should not breastfeed their infants. Atorvastatin is contraindicated during breastfeeding.

Precautions & Warnings of Tablet :- Atova 40 mg (AS A Atorvastatin Calcium AS A Other Anti-anginal & Anti-ischaemic drugs, Statins).

 

Liver effects: Liver function tests should be performed before the initiation of treatment and periodically thereafter. Atova should be used with caution in patients who consume substantial quantities of alcohol or have a history of liver disease. Atova therapy should be discontinued if markedly elevated CPK levels occur or myopathy is diagnosed or suspected.

৪। Anti -remodeling drug Losartan 25 mg দিবে,

cardiac remodeling prevent করার জন্য।

কার্ডিয়াক রিমডেলিং কি?

কার্ডিয়াক রিমডেলিং এমন একটি শব্দ যা হার্টের আকার এবং আকৃতির পরিবর্তনগুলিকে বোঝায় যা কার্ডিয়াক রোগ বা কার্ডিয়াক ক্ষতির প্রতিক্রিয়ায় ঘটে । ডাক্তাররা যখন “রিমডেলিং” সম্পর্কে কথা বলেন, তখন তারা সাধারণত বাম ভেন্ট্রিকলের কথা বলেন, যদিও মাঝে মাঝে এই শব্দটি অন্যান্য কার্ডিয়াক চেম্বারে প্রয়োগ করা হয়।

Tablet :-Angilock  25 mg (AS A Losartan Potassium AS A Angiotensin-ll receptor blocker)

Indications of Tablet :-Angilock  25 mg (AS A Losartan Potassium AS A Angiotensin-ll receptor blocker):-

 

Hypertension: Angilock tablet is indicated for the treatment of hypertension. It may be used alone or in combination with other antihypertensive agents (eg. thiazide diuretics).

Renal Protection in Type-2 Diabetic Patients with Proteinuria: Angilock tablet is indicated to delay the progression of renal disease in hypertensive type-2 diabetics with proteinuria, defined as urinary albumin to creatinine ratio >300 mg/g.

Pharmacology of Tablet :-Angilock  25 mg (AS A Losartan Potassium AS A Angiotensin-ll receptor blocker):-

 

Losartan Potassium is the first non-peptide orally active angiotensin II receptor blocker. It binds to the AT1 receptor found in many tissues (e.g. vascular smooth muscle, adrenal gland, kidneys and the heart) and reduces several important biological actions including vasoconstriction and the release of aldosterone responsible for hypertension.

Dosage & Administration of Tablet :-Angilock  25 mg (AS A Losartan Potassium AS A Angiotensin-ll receptor blocker):-

 

The usual starting and maintenance dose is 50 mg once daily for most patients. If the antihypertensive effect using 50 mg once daily is inadequate, 25 mg twice daily is recommended prior to increasing the dose. For patients with intravascular volume-depletion (e.g., those treated with high-dose diuretics), a starting dose of 25 mg once daily should be considered. Losartan Potassium can be administered once or twice daily. The total daily dose ranges from 25 mg to 100 mg.

Patients upto 75 years: No initial dosage adjustment is necessary for this group of patients.

Patients over 75 years: Presently there is limited clinical experience in this group; a lower starting dose of 25 mg once daily is recommended.

Interaction of Tablet :-Angilock  25 mg (AS A Losartan Potassium AS A Angiotensin-ll receptor blocker):-

 

Rifampicin and fluconazole reduce levels of active metabolite of Angilock. Concomitant use of Angilock and hydrochlorothiazide may lead to potentiation of the antihypertensive effects. Concomitant use of potassium-sparing diuretics (eg, spironolactone, triamterene, amiloride), potassium supplements or salt substitutes containing potassium may lead to increases in serum potassium. The antihypertensive effect of losartan may be attenuated by the non-steroidal anti-inflammatory drug indomethacin. The use of ACE-inhibitor, angiotensin receptor antagonist, an anti-inflammatory drug and a thiazide diuretic at the same time increases the risk of renal impairment.

Contraindications of Tablet :-Angilock  25 mg (AS A Losartan Potassium AS A Angiotensin-ll receptor blocker):-

 

Losartan Potassium is contraindicated in pregnant women and in patients who are hypersensitive to any component of this product. Losartan Potassium should not be administered with Aliskiren in patients with diabetes.

Side Effects of Tablet :-Angilock  25 mg (AS A Losartan Potassium AS A Angiotensin-ll receptor blocker):-

 

The side effects with the use of Angilock are mild and transient in nature. The most common side effects are dizziness, diarrhea, nasal congestion, cough, upper respiratory infection. Other side effects are fatigue, oedema, abdominal pain, chest pain, nausea, headache & pharyngitis.

Pregnancy & Lactation of Tablet :-Angilock  25 mg (AS A Losartan Potassium AS A Angiotensin-ll receptor blocker):-

 

Pregnancy Category D. The risk to the fetus increases if Losartan Potassium is administered during the second or third trimesters of pregnancy. It is not known whether Losartan Potassium is excreted in human milk, as many drugs are excreted in human milk and because of the potential for adverse effects on the nursing infant, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.

৫৷ হার্ট রেট বেশি থাকলে হার্ট কে রিলাক্স করার জন্য Low dose e একটা বিটা ব্লকার দিবে, যা হার্টের রেট কমাবে, তবে force of contraction কমাবেনা,Metoprolol 25 mg stat dibe,

Tablet 6:- Betaloc 25 mg AS A Metoprolol Tartrate AS A Beta adrenoceptor blocking drugs Group 2 Anti arrhythmic Drug.

Indications of Tablet :-Betaloc 25 mg AS A Metoprolol Tartrate AS A Beta adrenoceptor blocking drugs Group 2 Anti arrhythmic Drug:-

ln the management of hypertension and angina pectoris. Cardiac arrhythmias, especially supraventricular tachyarrhythmias. Adjunct to the treatment of hyperthyroidism. Early intervention with Betaloc in acute myocardial infarction reduces infarct size and the incidence of ventricular fibrillation. Pain relief may also decrease the need for opiate analgesics. Betaloc has been shown to reduce mortality when administered to patients with acute myocardial infarction.

Pharmacology of Tablet :-Betaloc 25 mg AS A Metoprolol Tartrate AS A Beta adrenoceptor blocking drugs Group 2 Anti arrhythmic Drug:-

Metoprolol is a selective beta1-blocker. Metoprolol reduces or inhibits the agonistic effect on the heart of catecholamines (which are released during physical and mental stress). This means that the usual increase in heart rate, cardiac output, cardiac contractility and blood pressure, produced by the acute increase in catecholamines, is reduced by Metoprolol. Metoprolol interferes less with Insulin release and carbohydrate metabolism than do non-selective beta-blockers. Metoprolol interferes much less with the cardiovascular response to hypoglycaemia than do non-selective beta-blockers.

Dosage & Administration of Tablet :-Betaloc 25 mg AS A Metoprolol Tartrate AS A Beta adrenoceptor blocking drugs Group 2 Anti arrhythmic Drug:-

Film-coated tablet–

• Hypertension: Total daily dosage Metoprolol 100-400 mg to be given as a single or twice-daily dose. The starting dose is 100 mg (two Metoprolol-50 tablets) per day. This may be increased by 100 mg per day at weekly intervals. lf full control is not achieved using a single daily dose, a b.i.d. regimen should be initiated. Combination therapy with a diuretic or other antihypertensive agents may also be considered.
• Angina: Usually Metoprolol 50 mg (one Metoprolol-50 tablet) to 100 mg (two Metoprolol-50 tablets) twice or three times daily.
• Cardiac arrhythmias: Metoprolol 50 mg (one Metoprolol-50 tablet) b.i.d or t.i.d should usually control the condition. It is necessary the dose can be increased up to 300 mg per day in divided doses. Following the treatment of an acute arrhythmia with Metoprolol injection, continuation therapy with Metoprolol tablets should be initiated 4-6 hours later. The initial oral dose should not exceed 50 mg t.i.d.
• Hyperthyroidism: Metoprolol 50 mg (one Metoprolol-50 tablet) four times a day. The dose should be reduced as the euthyroid state is achieved.
• Myocardial infarction: Orally, therapy should commence 15 minutes after the last injection with 50 mg every 6 hours for 48 hours. Patients who fail to tolerate the full intravenous dose should be given half the suggested oral dose. Maintenance- The usual maintenance dose is 200 mg daily given in divided doses. Elderly’ There are no special dosage requirements in otherwise healthy elderly patients. Significant hepatic dysfunction: A reduction in dosage may be necessary.

Extended-release tablet-

• Hypertension: The usual initial dosage is 25 to 100 mg daily in a single dose, whether used alone or added to a diuretic.
• Angina Pectoris: The dosage of extended-release Metoprolol Succinate should be individualized. The usual initial dosage is 100 mg daily, in a single dose.
• Heart Failure: The recommended starting dose of sustained-release Metoprolol Succinate is 25 mg once daily for two weeks in patients with NYHA class II heart failure and 12.5 mg once daily in patients with more severe heart failure. The dosage may be increased at weekly (or longer) intervals until optimum blood pressure reduction is achieved. If treatment is to be discontinued, the dosage should be reduced gradually over a period of 1-2 weeks.

IV Injection-

• Arrhythmias: By intravenous injection, up to 5 mg at a rate of 1-2 mg/minute, repeated after 5 minutes if necessary, total dose 10-15 mg.
• In surgery: By slow intravenous injection 2-4 mg at induction or to control arrhythmias developing during anaesthesia; 2 mg doses may be repeated to a maximum of 10 mg.
• Myocardial Infarction: Early intervention within 12 hours of infarction, by intravenous injection 5 mg every 2 minutes to a maximum of 15 mg, followed after 15 minutes by 50 mg by mouth every 6 hours for 48 hours; maintenance 200 mg daily in divided doses.

Interaction of Tablet :-Betaloc 25 mg AS A Metoprolol Tartrate AS A Beta adrenoceptor blocking drugs Group 2 Anti arrhythmic Drug:-

Catecholamine‐depleting drugs (e.g. Reserpine, Monoamine Oxidase (MAO) inhibitors) may have an additive effect when given with beta‐blocking agents. Drugs that inhibit CYP2D6 such as quinidine, fluoxetine, paroxetine and propafenone are likely to increase Betaloc concentration. These increases in plasma concentration would decrease the cardioselectivity of Betaloc. Concomitant use of digitalis glycosides and beta‐blockers can increase the risk of bradycardia. Beta‐blockers may exacerbate the rebound hypertension which can follow the withdrawal of clonidine.

Contraindications of Tablet :-Betaloc 25 mg AS A Metoprolol Tartrate AS A Beta adrenoceptor blocking drugs Group 2 Anti arrhythmic Drug:-

AV block, Uncontrolled heart failure, severe bradycardia, sick-sinus syndrome, cardiogenic shock and severe peripheral arterial disease. Known hypersensitivity to Metoprolol or other B-blockers. Metoprolol is also contra-indicated when myocardial infarction is complicated by significant bradycardia, first-degree heart block, systolic hypotension (<100mmHg) and/or severe heart failure.

Side Effects of Tablet :-Betaloc 25 mg AS A Metoprolol Tartrate AS A Beta adrenoceptor blocking drugs Group 2 Anti arrhythmic Drug:-

Tiredness, dizziness, depression, diarrhea, itching or rash, shortness of breath, slow heart rate, mental confusion, headache, somnolence, nightmares, insomnia, dyspnea, Nausea, dry mouth, gastric pain, constipation, flatulence, digestive tract disorders, heartburn, pruritus, musculoskeletal pain, blurred vision, decreased libido, and tinnitus have also been reported, intensification of AV block.

Pregnancy & Lactation of Tablet :-Betaloc 25 mg AS A Metoprolol Tartrate AS A Beta adrenoceptor blocking drugs Group 2 Anti arrhythmic Drug:-

Pregnancy Category C. There are no adequate and well‐controlled studies in pregnant women. This drug should be used during pregnancy only if clearly needed. Metoprolol is excreted in breast milk in very small quantities. Caution should be exercised when Metoprolol is administered to a nursing woman.

পেশেন্টের প্রচন্ড বুকে ব্যাথা থাকে, তাই পেইন কমানোর জন্য

Morphine /pethedin দিবে,\

Tablet 7:-MSL-Retard 15 mg (AS A Morphine Sulfate AS A Opioid analgesics).

Indications of Tablet :-MSL-Retard 15 mg (AS A Morphine Sulfate AS A Opioid analgesics).

MSL Retard Sulphate is indicated for the prolonged relief of severe & intractable pain, and for the relief of post-operative pain.

Pharmacology of Tablet :-MSL-Retard 15 mg (AS A Morphine Sulfate AS A Opioid analgesics).

Morphine is a phenanthrene derivative which acts mainly on the CNS and smooth muscles. It binds to opiate receptors in the CNS altering pain perception and response. Analgesia, euphoria and dependence are thought to be due to its action at the mu-1 receptors while resp depression and inhibition of intestinal movements are due to action at the mu-2 receptors. Spinal analgesia is mediated by morphine agonist action at the K receptor.

Dosage & Administration of Tablet :-MSL-Retard 15 mg (AS A Morphine Sulfate AS A Opioid analgesics).

15 mg retard tablet:

Adults: A patient presenting with severe pain, uncontrolled by weaker opioids (e.g. dihydrocodeine) should normally be started on 30 mg 12 hourly. Patients previously on normal release oral morphine should be given the same total daily dose as Morphine Sulphate 15 mg tablets but in divided doses at 12-hourly intervals. Increasing severity of pain will require an increased dosage of the tablets. Higher doses should be made, where possible in 30-50% increments as required. The correct dosage for any individual patient is that which is sufficient to control pain with no, or tolerable, side effects for a full 12 hours. Patients receiving Morphine Sulphate 15 mg tablets in place of parenteral morphine should be given a sufficiently increased dosage to compensate for any reduction in analgesic effects associated with oral administration. Usually such increased requirement is of the order of 100%. In such patients individual dose adjustments are required. Children: For children with severe cancer pain, a starting dose in the range of 0.2 to 0.8 mg morphine per kg bodyweight 12 hourly is recommended. Post-operative pain: Morphine Sulphate 15 mg tablets are not recommended in the first 24 hours post-operatively or until normal bowel function has returned; thereafter it is suggested that the following dosage schedule be observed at the physician’s discretion: (a) Morphine Sulphate 30 mg tablets 12 hourly to patients over 70 kg, (c) Elderly- a reduction in dosage may be advisable in the elderly, (d) Children- not recommended. Supplemental parenteral morphine may be given if required but with careful attention to the total dosages of morphine, and bearing in mind the prolonged effects of morphine in this prolonged release formulation.

10 mg tablet:

Adults and children over 12 years: The dosage of Morphine 10 mg tablet is dependent on the severity of pain and the patient’s previous history of analgesic requirements. One Morphine 10 mg tablet to be taken every four hours or as directed by a physician. Increasing severity of pain or tolerance to morphine will require increased dosage of Morphine 10 mg tablet to achieve the desired relief. Patients receiving morphine orally in place of parenteral morphine should be given a sufficiently increased dosage to compensate for any reduction in analgesic effects associated with oral administration. Usually such increased requirement is of the order of 100%. In such patients individual dose adjustments are required. Elderly: A reduction in adult dosage may be advisable. Children 3-12 years of age: 3-5 years- 5 mg, 4-hourly; 6-12 years- 5-10 mg, 4-hourly.

Oral Solution:

• Adults: Usual dose 10-20 mg (5-10 ml) every 4 hours.
• Children 13 to 18 years: Maximum single dose 5-20 mg (2.5-10 ml) every 4 hours
• Children 6-12 years: Maximum dose 5-10 mg (2.5-5 ml) every 4 hours.
• Children 1-5 years: Maximum dose 5 mg (2.5 ml) every 4 hours.
• Children under 1 year: Not recommended.

Dosage can be increased under medical supervision according to the severity of the pain and the patient’s previous history of analgesic requirements. Reductions in dosage may be appropriate in the elderly, patients with moderate-severe renal or hepatic impairment, or where sedation is undesirable.

Morphine Sulfate is readily absorbed from the gastrointestinal tract following oral administration. However, when Oral Solution (5 mg/5 ml) is used in place of parenteral morphine, a 50% to 100% increase in dosage is usually required in order to achieve the same level of analgesia

Interaction of Tablet :-MSL-Retard 15 mg (AS A Morphine Sulfate AS A Opioid analgesics).

MSL Retard should be used with caution in patients who are concurrently receiving other central nervous system depressants including sedatives or hypnotics, general anaesthetics, phenothiazines, other tranquilisers, muscle relaxants, antihypertensives and alcohol. Interactive effects resulting in respiratory depression, hypotension, profound sedation, or coma may result if these drugs are taken in combination with the usual doses of morphine. Mixed agonist/antagonist opioid analgesics (e.g. buprenorphine, nalbuphine, pentazocine) should not be administered to a patient who has received a course of therapy with a pure opioid agonist analgesic. Medicinal products that block the action of acetylcholine, for example antihistamines, anti-parkinsons and anti-emetics, may interact with morphine to potentiate the anticholinergic adverse effects. Cimetidine inhibits the metabolism of morphine. Monoamine oxidase inhibitors are known to interact with narcotic analgesics producing CNS excitation or depression with hyper- or hypotensive crisis. MSL Retard should not be co-administered with monoamine oxidase inhibitors or within two weeks of such therapy. Plasma concentrations of morphine may be reduced by rifampicin. Although there are no pharmacokinetic data available for concomitant use of ritonavir with morphine, ritonavir induces the hepatic enzymes responsible for the glucuronidation of morphine, and may possibly decrease plasma concentrations of morphine.

Contraindications of Tablet :-MSL-Retard 15 mg (AS A Morphine Sulfate AS A Opioid analgesics).

Hypersensitivity. Morphine Sulphate is contra-indicated in respiratory depression, head injury, obstructive airways disease, paralytic ileus, acute abdominal pain, delayed gastric emptying, known morphine sensitivity, acute hepatic disease, concurrent administration of mono-amine oxidase inhibitors or within two weeks of discontinuation of their use. Not recommended during pregnancy. Not recommended for children below 3 years of age.

Side Effects of Tablet :-MSL-Retard 15 mg (AS A Morphine Sulfate AS A Opioid analgesics).

In normal doses, the commonest side effects of morphine are nausea, vomiting, constipation and drowsiness. With chronic therapy, nausea and vomiting are unusual with morphine Sulphate tablets but should they occur the tablets can be readily combined with an anti-emetic if required. Constipation may be treated with appropriate laxatives. Psychiatric disorders: Common- confusion, insomnia. Nervous system disorders: Common- Dizziness, headache, involuntary muscle, contractions, somnolence. Gastrointestinal disorders: Very Common – Constipation, nausea; Common- abdominal pain, anorexia, dry mouth, vomiting. Skin and subcutaneous tissue disorders: Common- Hyperhidrosis, Rash. General disorders: Asthenic conditions, pruritus.

Pregnancy & Lactation of Tablet :-MSL-Retard 15 mg (AS A Morphine Sulfate AS A Opioid analgesics).

Morphine Sulphate is not recommended during pregnancy and labour due to the risk of neonatal respiratory depression. Administration to nursing mothers is not recommended as morphine is excreted in breast milk. Withdrawal symptoms may be observed in the new born of mothers undergoing chronic treatment.

Precautions & Warnings of Tablet :-MSL-Retard 15 mg (AS A Morphine Sulfate AS A Opioid analgesics).

The major risk of opioid excess is respiratory depression. As with all narcotics a reduction in dosage may be advisable in the elderly, in hypothyroidism, in renal and chronic hepatic disease. Use with caution in patients with impaired respiratory function, severe bronchial asthma, convulsive disorders, acute alcoholism, delirium tremens, raised intracranial pressure, hypotension with hypovolaemia, severe cor pulmonale, opioid dependent patients, patients with a history of substance abuse, diseases of the biliary tract, pancreatitis, inflammatory bowel disorders, prostatic hypertrophy, adrenocortical insufficiency. MSL Retard Sulphate tablets should not be used where there is a possibility of paralytic ileus occurring. If paralytic ileus be suspected or occur during use, MSL Retard Sulphate tablets should be discontinued immediately. MSL Retard may lower the seizure threshold in patients with a history of epilepsy. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine. The patient may develop tolerance to the drug with chronic use and require progressively higher doses to maintain pain control. Prolonged use of MSL Retard may lead to physical dependence and a withdrawal syndrome may occur upon abrupt cessation of therapy. When a patient no longer requires therapy with morphine, it may be advisable to taper the dose gradually to prevent symptoms of withdrawal. Hyperalgesia that will not respond to a further dose increase of morphine Sulphate may very rarely occur in particular in high doses. A morphine Sulphate dose reduction or change in opioid may be required. MSL Retard has an abuse profile similar to other strong agonist opioids. MSL Retard may be sought and abused by people with latent or manifest addiction disorders. There is potential for development of psychological dependence (addiction) to opioid analgesics, including morphine. The drug should be used with particular care in patients with a history of alcohol and drug abuse. Abuse of oral dosage forms by parenteral administration can be expected to result in serious adverse events, which may be fatal.

OR Injection 8.G-pethidine 50mg/ml 2ml ampoule AS A pethidine Hydrochloride AS A Opioid analgesics.

Indications of Injection:-G-pethidine 50mg/ml 2ml ampoule AS A pethidine Hydrochloride AS A Opioid analgesics:-

 

G-Pethidine is indicated for short-term (24-36 hours) relief of moderate to severe pain. It can be given via the following routes of administration: intramuscular, subcutaneous, slow intravenous bolus injection, intravenous infusion and patient controlled analgesia (PCA).

G-Pethidine is indicated for administration as an anaesthetic adjunct and for obstetric analgesia. An opioid antagonist and facilities for administration of oxygen and control of respiration should be immediately available during and immediately following intravenous administration of pethidine

Pharmacology of Injection:-G-pethidine 50mg/ml 2ml ampoule AS A pethidine Hydrochloride AS A Opioid analgesics:-

 

Pethidine is a phenylpiperidine derivative opioid analgesic. It acts mainly as mu-receptor agonist. Like most, opioid analgesics, it mimics endogenous opioids by activating opioid receptors in the central and peripheral nervous system. It reduces the release of neurotransmitter substances and also reduces the activity of postsynaptic neurons in the spinal cord thus preventing transmission of pain impulse.

Dosage & Administration of Injection:-G-pethidine 50mg/ml 2ml ampoule AS A pethidine Hydrochloride AS A Opioid analgesics:-

 

Adult Dosage:

Analgesia:

• Dosage should be adjusted according to the severity of pain and the response of the patient and also depends on patient profile eg: age, weight, sex, previous exposure to narcotics.
• 25 to 100 mg by IM (preferred) or S.C. injection, every 3 to 4 hours.
• 25 to 50 mg slow IV injection, every 3 to 4 hours 
• Usual dose is 200 mg/day by the IV route. Intravenous injection should be made very slowly, preferably using a diluted solution.
• For continuous intravenous infusion adequate analgesia should be established prior to commencement of the infusion. A dosage of 0.3 mg/kg/hr is recommended as the initial intravenous infusion rate.
• Clinical experience suggests that patients with normal renal function receiving more than 1000 mg/24 hrs pethidine are at particular risk of developing pethidine associated neurotoxicity (PAN). Patients receiving over 800 mg/24 hrs pethidine should usually be monitored for early signs of norpethidine toxicity

Obstetric Analgesia: 50 to 100 mg by IM (preferred) or S.C. injection, administered when pain becomes regular. May be repeated 3 to 4 times at one to three hour intervals if necessary. Maximum of 4 doses in 24 hours

Anaesthesia Adjunct: As premedication, intramuscular (preferred) or subcutaneous, 50 to 100 mg thirty to ninety minutes prior to anaesthesia. As an adjunct to anaesthesia, intravenous, by repeated slow injection of fractional doses of a solution diluted to 10 mg per mL. Dosage by this route should not exceed 25 to 50 mg. Dosage must be titrated to the needs of the patient, depending on the premedication given, the type of anaesthesia, and the nature and duration of the surgical procedure.

Patient-Controlled Analgesia:

• Patient-controlled analgesia (PCA) allows patients to assess their own level of pain and consequently titrate the amount of pethidine they require for adequate pain control against sedation and other side effects. Adequate analgesia should be established prior to commencement of PCA.
• The dosages and time intervals are preset into a microprocessor-controlled infusion pump. When the patient experiences pain, a button is depressed by the patient and a dose of pethidine is administered intravenously. If the patient should depress the button before the preset time interval (lockout interval) has elapsed, no extra drug is administered. For adults, demand doses, of 5 mg to a maximum of 20 mg pethidine have been given via PCA using a lockout interval of 6 to 20 minutes. Along with the self-administered dose of pethidine, some syringe pumps also deliver a background continuous infusion of pethidine at a basal rate. Some PCA pumps allow a maximum dosage over a defined period to be preset in order to avoid patient overdosage.
• The demand dosage and lockout interval should be determined according to the patient’s analgesic requirements. Patients receiving a background infusion of pethidine should generally receive a smaller demand dose relative to equivalent patients utilising a demand dose only.
• Clinical experience suggests that patients with normal renal function receiving more than 1000 mg/24hrs pethidine are at particular risk of developing pethidine associated neurotoxicity (PAN). Patients receiving over 800 mg/24hrs pethidine should usually be monitored for early signs of norpethidine toxicity. Pethidine-associated neurotoxicity is dose related, so pethidine should not be used for periods greater than 24 to 36 hours

Paediatric Dose:

• Analgesia: Intramuscular (preferred) or subcutaneous, 0.5 to 2 mg per kg of body weight, not to exceed 100 mg, every three to four hours as needed.
• Preoperative: Intramuscular (preferred) or subcutaneous, 1 to 2 mg per kg of body weight, not to exceed 100 mg, thirty to ninety minutes prior to anaesthesia.
• Neonates: Excretion and metabolism of pethidine in the neonate is reduced compared with adults. Safety has not been established in neonates and due to lack of data, no dosage regimen can be recommended.

Side Effects of Injection:-G-pethidine 50mg/ml 2ml ampoule AS A pethidine Hydrochloride AS A Opioid analgesics:-

 

Central Nervous System:  Lightheadedness, dizziness, sedation, sweating, bizarre feelings, disorientation, hallucinations, psychosis. Some of these effects seem to be more prominent in ambulatory patients and those not experiencing severe pain, and may be relieved by reducing the dose slightly and lying down.

Gastrointestinal: Nausea and vomiting, constipation.

Pregnancy & Lactation of Injection:-G-pethidine 50mg/ml 2ml ampoule AS A pethidine Hydrochloride AS A Opioid analgesics:-

 

Pregnancy Category C. Opioid analgesics may cause respiratory depression in the newborn infant. These products should therefore only be used after weighing the needs of the mother during labour against the risk to the foetus. Animal reproduction studies have not been conducted with pethidine hydrochloride and safe use in pregnancy prior to labour has not been established with regard to possible adverse effects on foetal development.

Breast-feeding: Pethidine is excreted in breast milk; however, clinical data on the rate of excretion or concentration of pethidine in breast milk is not available. The clinical significance of these findings is yet to be determined. It is not recommended that pethidine be administered to nursing mothers.

পরে কোনো contraindication না থাকলে streptokinase দিবে stat,

Injection 9:-STK Powder for injection 1.5 million unite (AS A Streptokinase AS A Fibrinolytics (Thrombolytics).)

Indications of Injection :-STK Powder for injection 1.5 million unite (AS A Streptokinase AS A Fibrinolytics (Thrombolytics).)

 

STK is indicated for use in the management of acute myocardial infarction, for the lysis of intracoronary thrombi, for the improvement of ventricular function, and reduction of mortality when administered by either the intravenous or intracoronary route. Earlier administration of STK is correlated with greater clinical benefit, the greatest benefit (in terms of mortality reduction) being seen when Streptase is administered within the first 4 hours after onset of symptoms. The treatment should always commence within 6 hours of the onset of pain.

Pharmacology of Injection :-STK Powder for injection 1.5 million unite (AS A Streptokinase AS A Fibrinolytics (Thrombolytics).)

 

Streptokinase forms a complex with plasminogen which then converts plasminogen to plasmin. Plasmin breaks down clots as well as fibrinogen and other plasma proteins.

Dosage & Administration of Injection :-STK Powder for injection 1.5 million unite (AS A Streptokinase AS A Fibrinolytics (Thrombolytics).)

 

Streptokinase can be reconstituted using 5 ml sodium chloride injection or 5% Dextrose Injection directing the diluent at the side of the vacuum packed vial rather than into drug powder

Acute Myocardial Infarction:

IV infusion:

• Vial size (IU): 15,00,000
• Total solution volume: 45 ml
• Infusion rate: Infuse 45 ml within 60 mins

Intracoronary infusion:

• Vial size (IU): 2,50,000
• Total solution volume: 125 ml
• 20,000 IU bolus, Infusion rate: Loading dose of 10 ml
• 2,000 IU/min. for 60 minutes, Infusion rate: 60 ml/hour

Pulmonary Embolism, Deep Vein Thrombosis, Arterial Thrombosis or Embolism:

• 2,50,000 IU loading dose over 30 min, Vial size (IU): 15,00,000, Total solution volume 90 ml, Infusion rate: Infuse 30 ml/hour for 30 min
• 1,00,000 IU/hour for maintenance dose, Infusion rate: Infuse 6 ml/hour

Interaction of Injection :-STK Powder for injection 1.5 million unite (AS A Streptokinase AS A Fibrinolytics (Thrombolytics).)

 

There is an increased risk of haemorrhage in patients simultaneously or previously receiving anticoagulants (such as Heparin or Coumarin derivatives) or drugs which inhibit platelet formation or function (e.g., Platelet aggregation inhibitors, Dextrans, Phenylbutazone, Dipyridamole, Non-steroidal anti-inflammatory drugs). The effect of Heparin can be neutralized rapidly by administration of Protamine Sulphate. The Thrombin time (TT) should not be more than twice the normal control value before thrombolytic therapy is started. In the case of prior treatment with coumarin derivatives, the International Normalized Ratio (INR) must be less than 1.3 before starting STK infusion.

Combination of STK with Aspirin for treatment of Myocardial infarction: Study showed a significant benefit to patients treated with these two agents after acute myocardial infarction. Mortality (both short and longer term) was reduced in these patients to a greater extent than in those treated with either agent alone.

Unless contraindicated, the concomitant use of Acetylsalicylic acid (ASA, Aspirin), starting prior to STK infusion and continued for one month thereafter may be instituted at the discretion of the physician. The benefit of combination therapy should therefore be weighed against the risk of increased haemorrhage.

Anticoagulation treatment following STK: Following high dose (1.5 million IU), short term treatment with STK, for acute myocardial infarction, the use of subsequent anticoagulant treatment has not yet been shown to be of unequivocal benefit. Therefore, in this situation, the use of anticoagulants should be decided by the physician.

Contraindications of Injection :-STK Powder for injection 1.5 million unite (AS A Streptokinase AS A Fibrinolytics (Thrombolytics).)

 

As thrombolytic therapy increases the risk of bleeding, Streptokinase, administered either systemically or locally, is contraindicated in the following situations:

Existing or recent haemorrhage and haemorrhagic diathesis (with the exception of consumption coagulopathy) Potential for internal bleeding (e.g., peptic ulcer, ulcerative colitis, diverticulitis or visceral tumours) All forms of reduced blood coagulability, in particular spontaneous fibrinolysis and extensive clotting disorders.

Recent (within 2 months) cerebrovascular accident, recent (within 10 days) facial or head trauma, intracranial or intraspinal surgery, known intracranial neoplasm and all known neoplasms with risk of haemorrhage 

Invasive operations, e.g., recent organ biopsy, invasive diagnostic procedure, recent implantation of a vessel prosthesis, long-term traumatic closed-chest massage or other recent surgery (until the 6th to 10th post operative day, depending on the severity of surgical intervention)

Arteriovenous malformation or aneurysm: Haemorrhagic diathesis including thrombocytopenia or pronounced hepatic or renal dysfunction 

Severe uncontrolled hypertension (systolic BP > 200 mm Hg, diastolic BP > 100 mm Hg), or hypertensive retinal changes grades III/IV), hypertonic fundus 

Severe liver or kidney damage: Simultaneous treatment with oral anticoagulants (International Normalized Ratio (INR) >1.3) 

Endocarditis or pericarditis (Immediately after streptococcal infections which have produced a high antiStreptokinase titre (acute rheumatic fever, acute glomerulo-nephritis, etc.). More than 5 days and less than 12 months since previous Streptokinase therapy.

Side Effects of Injection :-STK Powder for injection 1.5 million unite (AS A Streptokinase AS A Fibrinolytics (Thrombolytics).)

 

The following adverse reactions are based on experience from clinical trials and on post marketing experience of STK. 

General disorders:

• Common: Headache and back pain, muscle pain (including myalgia), chills and/or fever as well as asthenia/malaise.

Haemorrhage and bleeding:

• Common: Haemorrhages at invaded or disturbed sites, including the injection site, and ecchymoses. Gastrointestinal or genitourinary bleedings (including aggravation of menstrual bleeding), epistaxis. 
• Uncommon: Intracranial haemorrhages with their complications and possible fatal outcome, retinal haemorrhages, severe haemorrhages (also with fatal outcome) including liver haemorrhages, retroperitoneal bleedings, splenic rupture. Blood transfusions are rarely required.

Immune system disorders:

• Very common: Development of antiSTK antibodies 
• Common: Allergic-anaphylactic reactions such as rash, flushing, itching, urticaria, angioneurotic oedema, minor breathing difficulty, periorbital swelling, bronchospasm or hypotension.

Nervous system disorders:

• Rare: Neurologic symptoms (e.g., dizziness, confusion, paralysis, hemiparesis, agitation or convulsion) in the context of cerebral haemorrhages or cardiovascular disorders with hypoperfusion of the brain.

Cardiac complication and vascular disorders:

• Very common: Hypotension, heart rate and rhythm disorders, angina pectoris. 
• Common: Recurrent ischaemia, heart failure, reinfarction, cardiogenic shock, pericarditis, pulmonary oedema. 
• Uncommon: Cardiac arrest (leading to respiratory arrest), mitral insufficiency, pericardial effusion, cardiac tamponade, myocardial rupture, pulmonary or distal embolism.

Respiratory disorders:

• Very rare: Non-cardiogenic pulmonary oedema after intracoronary thrombolytic therapy in patients with extensive myocardial infarction.

Gastrointestinal disorders:

• Common: Nausea, diarrhoea, epigastric pain and vomiting.

Pregnancy & Lactation of Injection :-STK Powder for injection 1.5 million unite (AS A Streptokinase AS A Fibrinolytics (Thrombolytics).)

 

Pregnancy category C. It is not known whether Streptokinase is excreted in the breast milk, nor whether it has harmful effects on the newborn. In the absence of further information, it is recommended that breast-feeding be discontinued in women who are to receive Streptokinase.

Precautions & Warnings of Injection :-STK Powder for injection 1.5 million unite (AS A Streptokinase AS A Fibrinolytics (Thrombolytics).)

 

Because of the increased likelihood of resistance, due to antiSTK antibodies, retreatment with STK or STK-containing products may not be effective if administered between five days and twelve months of prior STK administration or Streptococcal infections, such as Streptococcal pharyngitis, acute rheumatic fever or acute glomerulonephritis secondary to a Streptococcal infection.

In principle, no thrombolytic treatment should be commenced before the 10th postoperative day. However, in cases of pulmonary embolism, the indication for earlier treatment may be very strong and after careful consideration of all the risks, STK may be given before the tenth postoperative day. The danger of bleeding from the operative area must, of course, be taken into account.
The danger of haemorrhage is increased by simultaneous or previous treatment with anticoagulants (e.g., Heparin) or substances which inhibit platelet formation or function. If the patient is under active heparinisation, it should be neutralised by the administration of protamine sulphate before the start of thrombolytic therapy. 

Repeated Administration: After administration of STK, the titre of antiSTK antibodies begins to rise after approximately one week, reaching a peak at 2 to 3 weeks and remains elevated for 8 to 12 months. Because of the increased likelihood of resistance, STK may not be effective if given during this period.

এর পর ব্লাড প্রেশার চেক করবে,

যদি পেশেন্ট কার্ডিওজনিক শকে চলে যায়, তথা SBP যদি ৯০ এর নিছে চলে যায়, তাহলে Inotropic drug use  শুরু করবে,

Noradrenalin /dopamine দিবে,

IV Infusion 10:-Noradrenaline Aguettant 4Mg/4ml 4ML Ampoule (AS A Norepinephrine Bitartrate AS A Alpha and Beta-adrenergic agonist).

Indications of IV Infusion:-Noradrenaline Aguettant 4Mg/4ml 4ML Ampoule (AS A Norepinephrine Bitartrate AS A Alpha and Beta-adrenergic agonist).):-

 

For blood pressure control in certain acute hypotensive states (e.g., pheochromocytomectomy, sympathectomy, poliomyelitis, spinal anesthesia, myocardial infarction, septicemia, blood transfusion, and drug reactions). As an adjunct in the treatment of cardiac arrest and profound hypotension.

Pharmacology of IV Infusion:-Noradrenaline Aguettant 4Mg/4ml 4ML Ampoule (AS A Norepinephrine Bitartrate AS A Alpha and Beta-adrenergic agonist).):-

 

 

Norepinephrine is a direct-acting sympathomimetic which stimulates β1- and α-adrenergic receptors. Its α-agonist effects cause vasoconstriction, thereby raising systolic and diastolic BP with reflex slowing of heart rate.

Dosage & Administration of IV Infusion:-Noradrenaline Aguettant 4Mg/4ml 4ML Ampoule (AS A Norepinephrine Bitartrate AS A Alpha and Beta-adrenergic agonist).):-

 

 

An infusion of Norepinephrine should be given into a large vein. Restoration of Blood Pressure in Acute Hypotensive States. Blood volume depletion should always be corrected as fully as possible before any vasopressor is administered. When, as an emergency measure, intraaortic pressures must be maintained to prevent cerebral or coronary artery ischemia, Norepinephrine can be administered before and concurrently with blood volume replacement.

Diluent: Norepinephrine should be diluted in 5 percent dextrose injection or 5 percent dextrose and sodium chloride injections. These dextrose containing fluids are protection against significant loss of potency due to oxidation. Administration in saline solution alone is not recommended. Whole blood or plasma, if indicated to increase blood volume, should be administered separately (for example, by use of a Y-tube and individual containers if given simultaneously).

Average Dosage: Add the content of the ampoule (4 mg/4 ml) of Norepinephrine to 1,000 mL of a 5 percent dextrose containing solution. Each ml of this dilution contains 4 mcg of the base of Norepinephrine. Give this solution by intravenous infusion. Insert a plastic intravenous catheter through a suitable bore needle well advanced centrally into the vein and securely fixed with adhesive tape, avoiding, if possible, a catheter tie-in technique as this promotes stasis. An IV drip chamber or other suitable metering device is essential to permit an accurate estimation of the rate of flow in drops per minute. After observing the response to an initial dose of 2 ml to 3 ml (from 8 mcg to 12 mcg of base) per minute, adjust the rate of flow to establish and maintain a low normal blood pressure (usually 80 mm Hg to 100 mm Hg systolic) sufficient to maintain the circulation to vital organs. In previously hypertensive patients, it is recommended that the blood pressure should be raised no higher than 40 mm Hg below the preexisting systolic pressure. The average maintenance dose ranges from 0.5 ml to 1 ml per minute (from 2 mcg to 4 mcg of base).

High Dosage: In all cases, dosage of Norepinephrine should be titrated according to the response of the patient. Occasionally much larger or even enormous daily doses (as high as 68 mg base or 17 ampoules) may be necessary if the patient remains hypotensive, but occult blood volume depletion should always be suspected and corrected when present. Central venous pressure monitoring is usually helpful in detecting and treating this situation.

Fluid Intake: The degree of dilution depends on clinical fluid volume requirements. If large volumes of fluid (dextrose) are needed at a flow rate that would involve an excessive dose of the pressor agent per unit of time, a solution more dilute than 4 mcg per ml should be used. On the other hand, when large volumes of fluid are clinically undesirable, a concentration greater than 4 mcg per ml may be necessary.

Duration of Therapy: The infusion should be continued until adequate blood pressure and tissue perfusion are maintained without therapy. Infusions of Norepinephrine should be reduced gradually, avoiding abrupt withdrawal. In some of the reported cases of vascular collapse due to acute myocardial infarction, treatment was required for up to six days.

Adjunctive Treatment in Cardiac Arrest: Infusions of Norepinephrine are usually administered intravenously during cardiac resuscitation to restore and maintain an adequate blood pressure after an effective heartbeat and ventilation have been established by other means. Norepinephrine powerful beta-adrenergic stimulating action is also thought to increase the strength and effectiveness of systolic contractions once they occur.

Average Dosage: To maintain systemic blood pressure during the management of cardiac arrest, Norepinephrine is used in the same manner as described under Restoration of Blood Pressure in Acute Hypotensive States. Do not use the solution if its color is pinkish or darker than slightly yellow or if it contains a precipitate. Avoid contact with iron salts, alkalis, or oxidizing agents.

Interaction of IV Infusion:-Noradrenaline Aguettant 4Mg/4ml 4ML Ampoule (AS A Norepinephrine Bitartrate AS A Alpha and Beta-adrenergic agonist). ):-

 

 

Cyclopropane and halothane anesthetics increase cardiac autonomic irritability and therefore seem to sensitize the myocardium to the action of intravenously administered epinephrine or norepinephrine. Hence, the use of Noradrenaline Aguettant during cyclopropane and halothane anesthesia is generally considered contraindicated because of the risk of producing ventricular tachycardia or fibrillation. The same type of cardiac arrhythmias may result from the use of Noradrenaline Aguettant in patients with profound hypoxia or hypercarbia. Noradrenaline Aguettant should be used with extreme caution in patients receiving monoamine oxidase inhibitors (MAOI) or antidepressants of the triptyline or imipramine types, because severe, prolonged hypertension may result.

Contraindications of IV Infusion:-Noradrenaline Aguettant 4Mg/4ml 4ML Ampoule (AS A Norepinephrine Bitartrate AS A Alpha and Beta-adrenergic agonist).):-

 

 

Norepinephrine should not be given to patients who are hypotensive from blood volume deficits except as an emergency measure to maintain coronary and cerebral artery perfusion until blood volume replacement therapy can be completed. If Norepinephrine is continuously administered to maintain blood pressure in the absence of blood volume replacement, the following may occur: severe peripheral and visceral vasoconstriction, decreased renal perfusion and urine output, poor systemic blood flow despite “normal” blood pressure, tissue hypoxia, and lactate acidosis. Norepinephrine should also not be given to patients with mesenteric or peripheral vascular thrombosis (because of the risk of increasing ischemia and extending the area of infarction) unless, in the opinion of the attending physician, the administration of Norepinephrine is necessary as a life-saving procedure. Cyclopropane and halothane anesthetics increase cardiac autonomic irritability and therefore seem to sensitize the myocardium to the action of intravenously administered epinephrine or norepinephrine. Hence, the use of Norepinephrine during cyclopropane and halothane anesthesia is generally considered contraindicated because of the risk of producing ventricular tachycardia or fibrillation. The same type of cardiac arrhythmias may result from the use of Norepinephrine in patients with profound hypoxia or hypercarbia.

Side Effects of IV Infusion:-Noradrenaline Aguettant 4Mg/4ml 4ML Ampoule (AS A Norepinephrine Bitartrate AS A Alpha and Beta-adrenergic agonist).):-

 

 

Body as a whole: Ischemic injury due to potent vasoconstrictor action and tissue hypoxia.

Cardiovascular System: Bradycardia, probably as a reflex result of a rise in blood pressure, arrhythmias.

Nervous System: Anxiety, transient headache.

Respiratory System: Respiratory difficulty.

Skin and Appendages: Extravasation necrosis at injection site. Prolonged administration of any potent vasopressor may result in plasma volume depletion which should be continuously corrected by appropriate fluid and electrolyte replacement therapy. If plasma volumes are not corrected, hypotension may recur when Noradrenaline Aguettant is discontinued, or blood pressure may be maintained at the risk of severe peripheral and visceral vasoconstriction (e.g., decreased renal perfusion) with diminution in blood flow and tissue perfusion with subsequent tissue hypoxia and lactic acidosis and possible ischemic injury. Gangrene of extremities has been rarely reported. Overdoses or conventional doses in hypersensitive persons (e.g., hyperthyroid patients) cause severe hypertension with violent headache, photophobia, stabbing retrosternal pain, pallor, intense sweating, and vomiting.

Pregnancy & Lactation of IV Infusion:-Noradrenaline Aguettant 4Mg/4ml 4ML Ampoule (AS A Norepinephrine Bitartrate AS A Alpha and Beta-adrenergic agonist).):-

 

 

Pregnancy Category C. Animal reproduction studies have not been conducted with Norepinephrine. It is also not known whether Norepinephrine can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Norepinephrine should be given to a pregnant woman only if clearly needed. It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Norepinephrine is administered to a nursing woman.

heart Rate 80 এর উপরে থাকলে Noradrenaline

Heart rate 80 এর নিছে থাকলে Dopamine use korbe

Injection 11:Myomine IV Injection (AS A Dopamine Hydrochloride 200mg/5ml  5ml ampoule.AS A Inotropic-sympathomimetics).

Indications of Injection :Myomine IV Injection (AS A Dopamine Hydrochloride 200mg/5ml  5ml ampoule.AS A Inotropic-sympathomimetics).

Myomine is recommended for the correction of haemodynamic imbalance present in-

• Acute hypotension or shock associated with myocardial infarction, endotoxic septicaemia, trauma and renal failure.
• As an adjunct after open heart surgery, where there is persistent hypotension after correction of hypovolaemia.
• In chronic cardiac decompensation as in congestive failure.

Pharmacology of Injection :Myomine IV Injection (AS A Dopamine Hydrochloride 200mg/5ml  5ml ampoule.AS A Inotropic-sympathomimetics).

Dopamine is a preparation of Dopamine hydrochloride which can stimulate α, β and dopamine receptors. It is a natural catecholamine formed by the decarboxylation of 3,4-dihydroxyphenylalanine (DOPA). Dopamine is a precursor to norepinephrine in noradrenergic nerves and is also a neurotransmitter in certain areas of the central nervous system, especially in the nigrostriatal tract and in a few peripheral sympathetic nerves. It produces positive chronotropic and inotropic effects on the myocardium, resulting in increased heart rate and cardiac contractility. This is accomplished directly by exerting an agonist action on β-adrenoceptors and indirectly by causing release of norepinephrine from storage sites in sympathetic nerve endings. Dopamine does not cross the blood-brain barrier and so does not activate dopamine receptors in the brain.

Dosage of Injection :Myomine IV Injection (AS A Dopamine Hydrochloride 200mg/5ml  5ml ampoule.AS A Inotropic-sympathomimetics).

Adult dose: Where appropriate, the circulating blood volume must be restored with a suitable plasma expander or whole blood, prior to administration of dopamine. Begin infusion of dopamine hydrochloride solution at dosage of 2 to 5 micrograms/kg/min in patients who are likely to respond to a modest increment of heart force and renal perfusion.

In more seriously ill patients, begin infusion of dopamine hydrochloride solution at dosage of 5 micrograms/kg/min and increase gradually using 5 to 10 micrograms/kg/min increment up to 20 to 50 micrograms/kg/min as needed. If dosage in excess of 50 micrograms/kg/min are required, it is suggested that urine output should be checked frequently. In patients who do not respond to this doses, additional increments of dopamine may be given in an effort to achieve adequent blood pressure, urine flow and perfusion.

For patients with severe, refractory, chronic congestive heart failure doses should be started on 0.5 to 2 micrograms/kg/min, and the dose increased by 1 to 3 micrograms/kg/min as urinary output increases.

ECG, blood pressure and urine output should be monitored. Cardiac output and pulmonary wedge pressure should be monitored if possible.

Children less than 12 years old: The safety and efficacy of dopamine in children under 12 years has not been established.

Geriatric patients: No variation in dosage is suggested for geriatric patients. However, close monitoring is required for blood pressure, urine flow, and peripheral tissue perfusion.

Administration of Injection :Myomine IV Injection (AS A Dopamine Hydrochloride 200mg/5ml  5ml ampoule.AS A Inotropic-sympathomimetics).

Rate of administration: After dilution dopamine hydrochloride is administered intravenously through a suitable intravenous catheter or needle. An intravenous drip chamber or other suitable metering device is essential for controlling the rate of flow in drops per minute. Each patient must be individually titrated to the desired haemodynamic and/or renal response with dopamine hydrochloride. In titrating to the desired increase in systolic blood pressure, the optimum dosage rate for renal response may be exceeded, thus necessitating a reduction in rate after the haemodynamic condition is stabilized. Administration rate greater than 50 micrograms/kg/minute have safely been used in advanced circulatory decompensation states. If unnecessary fluid expansion is of concern, adjustment of drug concentration may be preferred over increasing the flow rate of a less concentrated dilution.

Interaction of Injection :Myomine IV Injection (AS A Dopamine Hydrochloride 200mg/5ml  5ml ampoule.AS A Inotropic-sympathomimetics).

The action of Myomine is potentiated by monoamine oxidase inhibitors (MAOI’s). The concurrent administration of cyclopropane or halogenated hydrocarbon anesthetics may cause ventricular arrhythmias. The cardiac effects of Myomine are antagonized by β – adrenergic blocking agents such as Propranolol and Metoprolol. The ergot alkaloids should be avoided because of the possibility of excessive vasoconstriction. Tricyclic antidepressants and guanethidine may potentiate the pressor response to Myomine. Hypotension and bradycardia have been observed in patients receiving Phenytoin. Myomine may increase the effect of diuretic agents. Peripheral vasoconstriction may be antagonized by α – adrenergic blocking agents, such as Phentolamine. Other vasodilators may also be useful in patients with heart failure, allowing greater inotropic and renal effects without the associated vasoconstriction. Care must be taken to avoid hypotension.

Contraindications of Injection :Myomine IV Injection (AS A Dopamine Hydrochloride 200mg/5ml  5ml ampoule.AS A Inotropic-sympathomimetics).

Dopamine hydrochloride is contraindicated in patients with known hypersensitivity to dopamine or any of its ingredients. It should not be used in patients with phaeochromocytoma, uncorrected tachyarrhythmias, or ventricular fibrillation. Dextrose solution without electrolytes should not be administered simultaneously with blood through the same infusion set because of the possibility of pseudoagglutination of red cells.

Side Effects of Injection :Myomine IV Injection (AS A Dopamine Hydrochloride 200mg/5ml  5ml ampoule.AS A Inotropic-sympathomimetics).

The most frequent reported adverse reactions are ectopic beats, nausea, vomiting, tachycardia, anginal pain, palpitations, dyspnoea, headache, hypotension, hypertension and vasoconstriction. Other less frequent adverse reactions are aberrant ventricular conduction, bradycardia, piloerection, mydriasis, widened QRS complex, azotaemia and elevated blood pressure. Peripheral ischemic gangrene in patients with pre-existing vascular disease. Fatal ventricular arrhythmias have been reported on rare occasions.

Pregnancy & Lactation of Injection :Myomine IV Injection (AS A Dopamine Hydrochloride 200mg/5ml  5ml ampoule.AS A Inotropic-sympathomimetics).

Animal studies have revealed no evidence of teratogenic effects from dopamine hydrochloride. The drug may be used in pregnant women when in the judgment of the physician the expected benefits outweigh the potential for risk to the fetus. It is not known if dopamine hydrochloride is excreted in breast milk, nor is the effect on the infant known. It is not recommended for breast-feeding mothers unless the expected benefits outweigh any potential risks

পরবর্তী ৫ দিন LMWH দিবে।

morphine/ pethidine , STK, Inotrop নিয়ে পরবর্তী পোস্টে আলোচনা করা হবে-

General Quaries:-

1.clopidogrel75, aspirin75 alada 4 tab na dea combination 4 dte kono somossa hbe vaiya?

Answer is:- na, kono somossa nai.

2.এইক্ষেত্রে bislol 2.5

কি দেয়া যায়?

Trimetazidine dihydrochloride দিবে কখন?

Answer is:- In india we use trimetazidine h ranolazine 500 and inj fondapainux 2.5..and aspirin clopid

B1 selective drug metoprolol in low dose and both beta alpha selective carvidelol is effective hoi.

3.inferior MI nidocard deayer আগে কিভাবে বোঝা যেতে পারে?

Answer is:-

ECG তে Inferior MI দেখতে হবে.

4.যারা পেরিফেরি তে আছে Morphine or pathidine দেয়ার সুযোগ নাই বা streptokinase দেয়ার সুযোগ নাই তারা কোন স্টেপ পর্যন্ত treatment দিবে?

Answer is:-

inj- Cardinex 60 mg   6000 Anti-Xa IU /0.6 ml S/C  (AS A Enoxaparin Sodium Parenteral anti-coagulants).Right to the umbilicus.

Indications of inj- Cardinex 60 mg   6000 Anti-Xa IU /0.6 ml S/C  (AS A Enoxaparin Sodium Parenteral anti-coagulants).

Cardinex is indicated in:

• Treatment of deep vein thrombosis, with or without pulmonary embolism.
• Treatment of unstable angina and non-Q-wave myocardial infarction, administered concurrently with aspirin.
• Prevention of thrombus formation in the extra-corporal circulation during haemodialysis.
• Prophylaxis of venous thromboembolic disease (prevention of blood clot formation in the veins), in particular those which may be associated with orthopedic or general surgery.
• Prophylaxis of venous thromboembolic disease in medical patients bedridden due to acute illness, including cardiac insufficiency, respiratory failure, severe infections, rheumatic diseases

Pharmacology inj- Cardinex 60 mg   6000 Anti-Xa IU /0.6 ml S/C  (AS A Enoxaparin Sodium Parenteral anti-coagulants).

Enoxaparin Sodium is a low molecular weight heparin with a high anti-Xa activity and low anti-lla or antithrombin activity. At doses required for the various indications, Enoxaparin Sodium does not increase bleeding time. At preventive doses, Enoxaparin Sodium causes no notable modification of activated Partial Thromboplastin Time (aPTT). It neither influences platelet aggregation nor binding of fibrinogen to platelets. Enoxaparin Sodium is primarily metabolised in the liver.

Dosage inj- Cardinex 60 mg   6000 Anti-Xa IU /0.6 ml S/C  (AS A Enoxaparin Sodium Parenteral anti-coagulants).

Treatment of deep vein thrombosis, with or without pulmonary embolism: Subcutaneously 100 anti-Xa lU/kg twice daily for 10 days or Subcutaneously 150 anti-Xa lU/kq once daily for 10 days. Oral anticoagulant therapy should be initiated when appropriate and Enoxaparin Sodium treatment should be continued until a therapeutic anticoaqulant effect has been achieved.

Treatment of unstable angina and non-Q-wave myocardial infarction, administered concurrently with aspirin: Subcutaneously 100 anti-Xa lU/kg twice daily for 2- 8 days. Should be administered concurrently with oral aspirin (100 to 325 mg once daily). Treatment with Enoxaparin Sodium in these patients should be prescribed fora minimum of 2 days and continued until clinical stabilization.

Prevention of thrombus formation in extra corporeal circulation during hemodialysis: Recommended dose is 100 anti-Xa lU/kg. For patients with a high risk of hemorrhage, the dose should be reduced to 50 anti-Xa lU/kg for double vascular access or 75 anti-Xa lU/kg for single vascular access. During hemodialysis, Enoxaparin Sodium should be introduced into the arterial line of the circuit at the beqinninq of the dialysis session.

Prophylaxis of venous thromboembolic disease in surgical patients:

• Patients undergoing general surgery with a moderate risk of thromboembolism (e.g. abdominal surgery): Subcutaneously 2000 anti-Xa IU (0.2 ml) or 4000 anti-Xa IU (0.4 ml) once daily for 7 to 10 days. The first injection should be given 2 hours before the surgical procedure.
• Patients undergoing orthopedic surgery with a high risk of thromboembolism: Subcutaneously 4000 anti-Xa IU (0.4 ml) once daily for 7 to 10 days. The first injection should be given 12 hours before the surgical procedure. Longer treatment duration may be appropriate in some patients like continued therapy with 4000 anti-Xa IU once daily for 3 weeks following the initial therapy has been proven to be beneficial in orthopaedic surqery.

Prophylaxis of venous thromboembolic disease in medical patients: Subcutaneously 4000 anti-Xa IU (0.4 ml) once daily for 6- 14 days.

Side Effects inj- Cardinex 60 mg   6000 Anti-Xa IU /0.6 ml S/C  (AS A Enoxaparin Sodium Parenteral anti-coagulants).

 

Haemorrhage (bleeding), Thrombocytopenia, elevations of serum aminotransferase. Pain, bluish marks at injection sites to skin rash at injection sites. Cases of neuraxial hematomas with the concurrent use of Cardinex and spinal/epidural anesthesia or spinal puncture have resulted in varying degrees of neurologic injuries.

Pregnancy & Lactation inj- Cardinex 60 mg   6000 Anti-Xa IU /0.6 ml S/C  (AS A Enoxaparin Sodium Parenteral anti-coagulants).

 

Pregnancy category B. In humans, there is no evidence that Enoxaparin Sodium crosses the placental barrier. As there are no adequate and well-controlled studies in pregnant women, Enoxaparin Sodium should be used during pregnancy only if clearly needed. Pregnant women with mechanical prosthetic heart valves may be at a higher risk for thromboembolism.

It is not known whether Enoxaparin is excreted in human milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or discontinue Enoxaparin, taking into account the importance of Enoxaparin to the mother and the known benefits of nursing.

Raiyyan Tahsan Date:29-12-2024 Sunday Time:11-13-35 PM.

• TC(1487).(56). General Medicine Department Case No (14): Presumed Treated Hypertension and Type 2 Diabetes with Possible Upper-GI Dyspepsia/Dysmotility and Cardiovascular Risk Management (1 Prescription + 0 Reports + 0 Supporting Images).5432
• TC(1486).(02). Dermatology Department Case No 107:- Suspected Superficial Dermatophytosis with Possible Coexisting Allergic Rhinitis: Clinical Diagnosis, Prescription Analysis and Evidence-Based Management (1PR+0RE+0IMG)4433
• TC(1485).(02). Dermatology Department Case No (106): Undifferentiated Genital Ulcer Disease with Associated Skin Rash and Generalized Weakness Suspected Syphilis versus Genital Herpes; Possible Secondary Bacterial Infection (1 PR+ 0RE + 0Img)7799
• TC(1484).(09).Obstetrics & Gynecology Case No 60:-High-Risk Pregnancy with History of Two Preterm Deliveries and Two Neonatal Deaths: Diagnosis, Drug Safety and Evidence-Based Management(1PR+0RE+0IMG)8090
• TC(1483).(09). Gynecology Department Case No. (59): Physician-Documented Mastitis with Fever — Possible Inflammatory or Bacterial Mastitis; Breast Abscess and Dengue Fever to Be Excluded (1Prescription + 0Reports + 0Images)0909

Search

Search